I beg to move,
That this House has considered the future of breast cancer.
It is a pleasure to serve under your chairmanship, Mr McCabe, and to have been selected to introduce this important debate. I welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and, of course, the Minister. Their presence underlines the importance of this issue. I also welcome everybody in the Public Gallery, many of whom have had personal experience of breast cancer, and all other hon. Members here today. It is important that we demonstrate our commitment to raising the profile of this issue across the party political divide. I am sure we have all been touched by this terrible disease in some way in our own lives.
I pay tribute to the remarkable people up and down the country who raise awareness of breast cancer and fight against it in their everyday lives. I want to take this opportunity to mention Rachael Bland, the BBC Radio 5 Live newsreader and presenter, who sadly passed away on 5 September. She did a remarkable thing by blogging about her experience in “Big C. Little Me.” and bringing down the barriers when it comes to living with breast cancer. Her strength and courage touched many of us, and her family and friends should be incredibly proud of her.
Between 2014 and 2016, an average of 457 women a year developed breast cancer in the South Cheshire clinical commissioning group area, which covers my constituency of Crewe and Nantwich. Sadly, in the same period, an average of 101 women lost their lives to the disease.
Today is World Menopause Day. It may seem odd that I have chosen to start my speech by talking about what might, at first glance, appear to be an unrelated issue, but the reverse is true. Breast cancer is most commonly diagnosed in women between the age of 50 and 65—the age at which women undergo the menopause. Some breast cancer treatments can bring about menopause symptoms, because they reduce oestrogen levels in the body. To make matters worse, women diagnosed with breast cancer usually cannot use hormone replacement therapy, the primary treatment for menopause symptoms, because there is strong evidence that it can increase the risk of breast cancer coming back. Some might ask whether it is really a big enough issue to warrant special attention, but we cannot afford not to pay special attention to it.
It is absolutely vital that we continue the fight to ensure that those diagnosed with breast cancer live, but we must also fight to improve their quality of life. About 70% of women with breast cancer experience severe night sweats and hot flushes, which cause major physical discomfort and anxiety, and affect their confidence. In some cases, they can even lead to serious sleep deprivation. Such problems can persist for many years. The severe and persistent symptoms of menopause are one of the main factors contributing to women discontinuing their treatment. Given that doing so can increase the chance that their breast cancer will come back, we have simply got to take this issue seriously.
What can be done? Professor Fenlon of Swansea University believes that cognitive behavioural therapy can help to ease physical symptoms, and is leading a clinical trial to assess how feasible it would be to train breast cancer nurses to deliver it. If clinical trials deem it to be effective, it has the potential to improve the quality of life of half a million women living with or beyond breast cancer in the UK, so I urge the Government to provide the NHS with resources to make the programme available in all our hospitals.
That brings me to the next issue I want to focus on: the geographical inequality in treatments and related services. It is important that the advances that I hope we are about to make in this area benefit everyone. The main CCG covering my constituents is NHS South Cheshire. I am proud to say that it was recently rated outstanding based on four pan-cancer measures, including waiting times, one-year survival rates and patient experience.
However, the report by the all-party parliamentary group on breast cancer states that there is a postcode lottery for breast cancer outcomes. All hon. Members will agree that it is simply unacceptable that women in some areas are more than twice as likely to die prematurely as women who are treated elsewhere. My CCG is set to merge with three others in the near future, and I want to ensure that my constituents continue to see waiting times fall, survival rates rise and the patient experience improve. I was shocked to read that women in some areas are one third less likely to have attended breast cancer screenings in the past three years than women living in other parts of the country.
Patients have had issues accessing off-patent drugs such as bisphosphonates, which were originally licensed for the treatment of osteoporosis but were discovered to be effective in preventing breast cancer recurrence in some post-menopausal women. When CCGs were asked last year whether they routinely fund bisphosphonates for that purpose, only 42—20%—said that they did. At the time, South Cheshire CCG said it was not doing so. I hope that the situation has improved, given that the National Institute for Health and Care Excellence has recently published updated clinical guidelines that recommend bisphosphonates. I am currently waiting to hear back from South Cheshire CCG. Is there an opportunity for the Government to make some specific interventions in the NHS long-term plan to prevent more cases of secondary breast cancer?
There is currently little incentive for manufacturers to license off-patent drugs for new uses in breast cancer. Breast Cancer Now is calling on the Government to introduce a catalyst fund in the NHS long-term plan to provide that incentive. That would make it quicker and easier for patients routinely to access cheap off-patent drugs. Breast Cancer Now commissioned York Health Economics Consortium to model how many lives we could save if the best outcomes were reached everywhere. It found that more than 1,100 lives could have been saved in 2016 if all CCGs in England had been able to reduce their mortality rates to match the lowest. Geographical inequality is not just an issue of principle; we have the potential to save lives, and if we save only one life, does that not make it worth addressing?
I would be grateful to hear from the Minister about the steps he is taking to facilitate the sharing of best practice between cancer alliances to reduce those variations. What conversations has he had with the Chancellor and his Treasury colleagues to ensure the long-term funding of cancer alliances?
If cancer alliances are properly to invest in the future of services and plan strategically, we must provide them with multi-year budgets. The APPG’s report on geographical inequality highlights that there are still worrying gaps in data collection, including in relation to the number of people living with secondary breast cancer. It is absolutely essential that we improve the cancer dashboard with more detailed performance data. After all, identifying and understanding these inequalities is the first step towards addressing them.
It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Crewe and Nantwich (Laura Smith) for leading the debate with such care, passion and expertise. It is a great pleasure to note that the three Front-Bench spokespeople—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and the hon. Member for Central Ayrshire (Dr Whitford) —have all served as chairs of the all-party parliamentary group on breast cancer. It is a rarity for all three Front-Bench spokespeople to have so much knowledge and, indeed, to care so much about the issue that they have spent their time campaigning on it in Parliament. I salute all three of them for their work on this matter and I very much look forward their contributions.
The statistics are well known and well rehearsed, but I want to put them on record. In the UK, 55,000 women and 350 men are diagnosed with breast cancer every year. Sadly, one in eight women will be diagnosed with breast cancer, 35,000 women are living with secondary breast cancer, and nearly 1,000 women die from breast cancer every month. Nearly 700,000 people in the UK are living either with or beyond breast cancer treatment. The positive that we can look at now is that 80% of women survive for five years or more. The title of the debate on the Order Paper, “Future of breast cancer”, is crucial, because it is all about the future. The progress made so far has been absolutely extraordinary, but we must not rest on that progress; we must look further forward and do even more, as science and medical developments allow us to.
I would probably have trotted out those statistics a couple of years ago when speaking on this matter, because it impacts on my constituents. However, personal experience of a loved one being struck down with breast cancer makes me more determined to be here to represent their cause and that of the thousands of women across the country who have to go through the same experience. I salute the courage and bravery of all who have been diagnosed with breast cancer and who have gone through the treatment. To watch those people undertake that brave journey is a humbling experience, because when I saw it with my own eyes, I thought, “Could I actually do this? Would I have the bravery and the strength to go through this myself?” It was the most extraordinary experience for me to see that.
I pay tribute to all the carers and those who provide support. They feel helpless, at times, and they wish that they could go through the wretched experience instead. They would do anything to change places, but they cannot. Those people do the most amazing job. On behalf of those who have been through the treatment, I salute all the brave families, friends and loved ones who went through it with them. The inner strength that their support must give to sufferers is absolutely tremendous.
Breast screening uptake is at its lowest level for 10 years, which is very concerning. Uptake is at 71%; the aim is to make that figure at least 80%, which would save 1,200 lives per year. If the Minister has time, I would like him to reassure us that the Government will take action in their attempt to reach that target. Screening is, of course, still age-based, and it was sad for me to note that the entry-level screening age would have been too high for the family member I referred to, who was only 42 when they were diagnosed.
It is incredibly exciting to meet groups such as Breast Cancer Now, which is carrying out a generation study, following 113,000 women from the UK over 40 years. I was absolutely blessed and fascinated to meet the people involved in that study at a recent all-party parliamentary group meeting. Of course, age is one profile, but we need to look at high-risk scenarios and investigate the genetic, lifestyle and environmental factors that can change the likelihood of a woman developing breast cancer. That study, which I think is exciting, identifies 160 common genetic changes associated with the development of breast cancer, as well as showing how various life events—such as the menopause—and lifestyle factors can have a great impact. The future is bright, because rather than just looking at age ranges, we are now really going into the detail with those studies to show how certain factors can lead to risk and then, where there is risk, providing screening. That is hugely important.
I paid tribute to those who go through breast cancer treatment and to their carers, who go through it with them, but I also want to touch on the phenomenal work that NHS staff do for everyone who goes through that journey. I thank them; they are the most extraordinary people, in terms of their sheer intelligence. It is incredibly reassuring to meet such bright, dedicated people. The other great thing about them is that they deal with everything in black and white—there is no messing around—and tell people exactly what is going on. It can sometimes be stark, but it reassures people that they are being led to the right conclusion.
Of course, there are workload impacts. We know that the NHS faces challenges, and cancer departments absolutely share those challenges. A Macmillan Cancer Support survey from last year highlighted the increased workloads, complex patient needs and vacancies in key roles that are putting pressure on the cancer care workforce. Certainly, in my experience with the Maidstone and Tunbridge Wells NHS Trust, the staff were absolutely phenomenal. When things did not work, it was often because they did not have what is called back-office support. As a result, consultants have to run around doing admin work instead of focusing on their medical and clinical expertise, making them very expensive and overqualified admin resources. We often talk quite clinically about back-office savings, but perhaps we need to look very carefully before making such savings if they will have an impact on frontline services.
Some of the NHS communications systems can be incredibly clunky. Finding out via Royal Mail that one has an appointment after the appointment is due to take place—not just once, but twice—is maddening. These days, we embrace technology. We are told about dentist appointments via text messages to which we can respond to confirm, and the NHS should be doing the same thing. Before my journey with breast cancer, I was critical of people who missed appointments, but I had not reflected that people might miss appointments because they have not been told that they are taking place. It is maddening for consultants, because once people have received their notification, they are not even required to reply to confirm that they will attend their appointment. Of course, no one in the hospital thinks, “Someone has not got back to me; perhaps they have not received the letter.” We sat waiting in the hospital for hours, because the system did not know we were there despite the fact that we had booked in. That is maddening for patients, and maddening for consultants and staff.
Such issues may seem quite trivial, but they caused me to go back to the hospital to meet the heads of service to ensure that I could convey the concerns of frontline staff to senior management. I thought that that was the least I could do after the care and attention that the staff had given us.
I therefore ask my hon. Friend the Minister to think about the support staff, the systems that are in place and how we can better support the staff who help us to get better. I express my immense gratitude for those people and the support, expertise and help that they provide, not just during the treatment but on the journey beyond. That is the other thing that I have noticed: once a patient is given the all-clear, which is the best news, all of a sudden they face another journey, on which they will not necessarily be with clinicians. They will still have support staff from organisations such as Macmillan, who take great care of people.
I find myself speaking from experience, having been on an incredible journey that taught me a great deal about those who go through cancer and those who care for us through cancer. It has made me vow that I will always do everything I can in Parliament to try to make the situation better. I look forward to those on the Front Benches reassuring us that they will do the same.
It is a pleasure to serve under your chairmanship, Mr McCabe.
I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith), my good friend, for introducing this debate. It is vital for us to have the opportunity to discuss the future of breast cancer care and treatment. I also place on the record my thanks to Breast Cancer Now, a fantastic organisation without which this debate would not be possible. I am an ambassador for Breast Cancer Now.
As people probably know by now, in 2010 my daughter, aged 35, was diagnosed with triple negative breast cancer. She was dead within 13 months. When I first came to Parliament, one of my aims was to do anything I could to ensure that that did not happen to other people and whatever I could to make things better.
This month is Wear it Pink Month. The timing of the debate could not be better—in Breast Cancer Awareness Month, with a new cancer strategy announced by the Prime Minister at her recent party conference and while the long-term economic plan for the NHS is being decided. This is an unprecedented opportunity to ensure that the way in which we prevent, diagnose and treat breast cancer, and care for those who have it, truly benefits all patients in every part of the country.
Every year about 55,000 people in the UK are diagnosed with breast cancer, making it the most common cancer in the country. One in eight women in the UK will develop breast cancer in their lifetime, and nearly 11,500 women and 80 men in the UK still lose their lives to breast cancer each year. Progress has been made, but survival outcomes vary significantly between regions across the country, and Britain continues to trail other European countries on breast cancer survival. As Members can imagine, that sort of statistic hits home with me.
Debates such as this one, along with the necessary commitments from the Government, are crucial if we are to work towards a future in which everyone with breast cancer can live, and live well. After three decades of progress in the UK, however, within four years the number of women dying from breast cancer each year is projected to rise, according to recent analysis. We have to address that—an increase simply cannot be allowed to happen.
What we need is action; we do not need platitudes or promises, because neither of those leads to improvements in care. We need some real action. I appreciate that the hon. Member for Bexhill and Battle (Huw Merriman) means well, and it is all very well to praise NHS staff, but at the end of the day we cannot spend a pat on the back. Someone needs to go back to the Prime Minister to tell her that we actually need to pay NHS staff properly.
Incidence rates are projected to increase in the next decade, but waiting times still vary widely, screening attendance is at a record low, secondary patient needs are still too often unmet, and the quality of care still depends far too much on where someone happens to live. My daughter did not have a cancer clinical nurse specialist, a CNS, and when her cancer metastasised—she was diagnosed at the end of April, and it metastasised by the following February—she tried to get her GP to visit her. The GP lived quite a distance away and would not come out; even after I made a number of phone calls, she still would not come out.
My daughter lay in that bedroom with a cancer metastasising to her brain, but only had paracetamol and ibuprofen to take because she could not get a doctor out to her. Had she had a CNS, that would not have happened. For women to get nursing from a cancer specialist is crucial. Again, I know that the hon. Member for Bexhill and Battle means well, but seeing that and having to care for someone in that position did not give me inner strength—it broke my heart, and I hope that it never happens to anyone ever again.
It is not too late to prevent the projected decline in breast cancer survival rates. For example, were 10% of breast cancers diagnosed a stage earlier, an estimated 290 lives could be saved in just one year. My daughter could have been one of those. It is therefore vital that we raise awareness. A couple of weeks ago, I went out to our local shopping centre, the Waterside. My office manager and I had loads of leaflets from Breast Cancer Now—the little ones, which tell people how to check their breasts—and a stack of chocolate brownies that my younger daughter had made. I have to say that the leaflets went faster than the chocolate brownies, but we gave it all out in the end.
We could also prevent more than 1,200 breast cancer deaths by increasing breast screening uptake from the current low of 71% to the 80% standard set for breast screening units. Those figures show that if the Government act now, and act decisively, progress can continue to be made, more lives can be saved and quality of life can be improved.
The progress made on breast cancer over the years masks stark regional inequalities in diagnosis, treatment and care across the country. Having worked in our NHS, I am so proud of the values of universality, equality and fairness that are hardwired into the delivery of life-saving care. Under our national health service, your postcode should have no bearing on the care you receive.
Last Friday, I visited Lincoln’s breast unit and saw the brilliant staff doing an amazing job. To do such a fantastic job, they often leave late at night. They have an answerphone, so people can ring up and leave a message if they are worried about anything. Those girls do not go home at night until they have emptied all the messages on that machine—it does not matter what time it is, or if they were meant to have gone home an hour ago: they stay. I do not think they get paid for staying.
In Lincoln, the average incidence rate for breast cancer is slightly above the English average. Most worrying, however, is that Lincoln’s premature mortality rate was higher than the English average, and significantly higher than that of the neighbouring area of North Lincolnshire.
Having worked at first hand on hospital wards—I am an ex-nurse—I know how essential it is for patients, staff and quality of care that teams are appropriately staffed, and that regular, trained nurses are working—not agency staff. Staff should be in an area all the time, so they know what they are looking for, and to do that we need the reinstatement of nursing bursaries. That does not only go for nurses; we need them for radiographers as well, because the people who do the mammograms need three years of training in radiography and then an extra year on top of that. I was told that only last week, and there is a real shortage of them. The Government talk about their apprenticeships, but it takes four years to train an apprentice nurse, and people are just not taking up the training.
Only 21% of trusts in England have a dedicated clinical nurse specialist for secondary breast cancer patients. As I said just now, having a CNS is vital, so that is a shockingly bad statistic. Our dedicated NHS staff work around the clock to provide expert care. The minimum that they deserve is not to have to worry about filling the gaps in understaffed departments. I do not know whether people realise, but when nurses go to work in a hospital that is understaffed—that is, most of them—and another ward is short, they can be moved from one ward to another. They are still nurses, but they might not know quite as much about exactly what they are doing. That is really bad. Bursaries need to be reinstated so that we have enough nurses.
The Government must invest £39 million in recruitment to the breast imaging and diagnostic workforce, and they must provide funding for the 120 hospital trusts without a dedicated CNS post. To the first person who asks, “How do we do that in a time of austerity?”, I will say how—fair taxation is how. Every year, 23% of breast cancer cases could be avoided by simple lifestyle changes but, owing to austerity, public health budgets in 2017-18 were 5% less in real terms than they were in 2013-14. Over the same period, this Government have reduced corporation tax and taxes for the very rich.
The cut in public health budgets drastically reduces the capacity of local public health services to deliver life-saving preventive action. Not only is underfunding local public health services putting people’s lives at risk, but cost-cutting measures fail on their own terms. Investing in public health locally would not only save lives but result in long-term savings for our NHS. It is therefore essential that the NHS long-term plan secures the future of cancer alliances through a continued commitment of at least £200 million per year, in line with inflation. I hope that the Minister will make a real commitment to that. I do not want to hear how we all have to live within our means: we can do that and we ought to do it.
To conclude, it is fantastic to see this crucial debate receive the participation and thoughtful consideration that it deserves. I hope that the Government take on board the excellent range of proposals from Members in all parts of the House. Breast cancer is, after all, an issue that affects all of us. It would be a travesty if we allowed decades of progress to be undone, especially when the pathway to continued improvement is already laid out.
I urge the Government to support fully the delivery of breast cancer diagnosis, treatment and care. Ever since I was elected, I have wanted to work towards a future in which everyone with breast cancer can live, and live well. Breast Cancer Now has a pledge: that by 2050 no one should be dying of breast cancer. I hope that everyone across the House can join in that aim and that, in future years, we will look back on debates such as this as a crucial step in the eradication of breast cancer as a fatal disease.
It is always a pleasure to speak in any health debates—as my party’s health spokesperson, I am interested in them—but it is particularly pleasing to speak in this debate. I thank the hon. Member for Crewe and Nantwich (Laura Smith) for presenting the case so well and, through having secured the debate, giving us other MPs the opportunity to make a contribution. It is also always a pleasure to follow the hon. Member for Lincoln (Karen Lee). All of us in the Chamber today, or who were in the main Chamber when she spoke on this topic some time ago, will remember her contributions. I thank her for them.
I am pleased that we again have an opportunity to highlight breast cancer issues while we have the Minister’s attention. We all know he is deeply interested in this subject, and we look forward to his response. I also look forward to the contribution by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), because I know she has an interest in the subject, too. There may be few of us here, but I know everyone’s contribution will be significant.
Some 55,000 people in the UK are diagnosed with breast cancer every year. Breast Cancer Now’s new 55000Reasons campaign calls for investment in breast cancer to feature in the NHS’s long-term plan. That beseechment is worthy of the Minister’s attention. Some 11,500 women and 80 men in the UK still lose their lives to breast cancer every year. I know men are a smaller proportion of sufferers, but we sometimes forget that they can be susceptible to breast cancer; I was given a salient reminder of that while researching for the debate. We sometimes do not think about that, but we should be aware of it.
Does the hon. Gentleman recognise that although far fewer men suffer from breast cancer, because services—particularly support services—are designed for women, men often delay coming forward with concerns and find it difficult to access support? Because they still see breast cancer as a women’s issue, they are almost afraid to be open about it.
As always, the hon. Lady makes an intelligent contribution; I do not mean to say that nobody else does, but she always brings her knowledge of her subject to our debates. I told her beforehand that I looked forward to her contribution, because, as always, it will be full of information we can learn from.
The hon. Lady is right: as the men present will know, we hide our health problems. We do not go to the doctor as often as we should. We just grin and bear it—except in the case of man flu, when we are probably dying almost before it starts. I should not be facetious—that is not right. I am just saying we do not react in the way we should. As the hon. Lady said, when we do go to the health service, the services are not there. We need to address that.
Between 2012 and 2016, an average of 66 women a year were diagnosed with breast cancer in the Strangford constituency. On average, 20 of those women—almost 30%—lost their battle with breast cancer in each of those years. As the MP for Strangford, that puts the issue into perspective for me, but it also tells me that the survival rate is not as good as we would like. The hon. Member for Bexhill and Battle (Huw Merriman) referred to early diagnosis, which I will come to. That statistic represents 20 homes deprived of a mother, a daughter, a sister, an aunt or a friend.
Outcomes vary tremendously among clinical commissioning groups. We continue to lag behind other European countries, such as Sweden, Portugal, Malta, Germany and France, on breast cancer survival. Projections indicate that if current trends continue and we do not address the increase in the number of people diagnosed with the disease, the number of breast cancer deaths will begin to increase within four years. I know the Minister has a cancer strategy in place and is addressing these issues, but perhaps he will indicate what is happening.
Those projections are shocking when we consider how far cancer diagnostics and treatment have progressed. My colleague the hon. Member for North Down (Lady Hermon) told me this week that a good friend of hers—a 42-year-old—has just died from cancer. Again, the reality is pertinent for us all.
I said to the hon. Member for Crewe and Nantwich that these debates always seem to come at the time when we can relate to them best. A very good friend of our family was diagnosed with breast cancer and is going through all the radiotherapy treatment. She has lost all her hair, as so often happens, and wears a scarf. The treatment is quite harsh. She is a friend of my son and the wife, and she works just down the road from us. Her employers have been good with her—they have ensured that she can at least do some part-time work. It is important for people to have something to focus their mind on when things are difficult.
Breast cancer is no respecter of the person. The large number of people affected by it means that even seemingly incremental changes have a huge potential to save more lives. Before I highlight some of the Breast Cancer Now recommendations, let me thank the Library for its work on the excellent briefing for the debate, which outlines the things we need, including public awareness and screening. It states:
“On 2 May 2018 the Secretary of State for Health and Social Care reported to Parliament a serious failure in the national breast screening programme in England and announced an independent review to investigate.”
Again, perhaps the Minister will indicate where we are with that review.
I underline the need for access to breast cancer drugs for people who are going through the most difficult times. We all know it is not just the patient who suffers—their family suffer, too. The hon. Member for Lincoln referred to that in a very personal way, which we all understand. The cancer care strategy refers to earlier diagnosis. One of its priorities is:
“A shift towards faster testing and responding more quickly to patients who present with symptoms. A target that by 2020, 95% of patients referred by a GP will be definitively diagnosed and receive test results within four weeks.”
If we reach that wonderful target, we will certainly be going the right way.
I often say to the hon. Member for Central Ayrshire, (Dr Whitford) who speaks for the Scottish National party, that she genuinely—she knows I mean this—brings a wealth of knowledge to our debates. I also tell her that, in many cases, Scotland leads the way with some of its health strategies and plans. We should look at its cancer strategy, which was published in 2016 and deals with prevention, detection, diagnosis and treatment—and aftercare, too, which is so important.
People who suffer from breast cancer often worry about financial issues, because they have a mortgage to pay and a family to look after, and sometimes the lady is the breadwinner. We must have all those things in place, so I encourage the Minister to look at Scotland’s cancer strategy, which I know the hon. Lady will refer to, probably in some detail. We look forward to that.
The excellent Breast Cancer Now recommendations include: specific lifestyle interventions; optimising the screening programme through increased uptake; strengthening the workforce; introducing new technologies; developing a screening programme tailored to an individual’s risk so cancers may be detected earlier; and reducing variation by reinforcing the position and ambition of cancer alliances. We will do this better if we do it together—I often say we are better together in everything. We can certainly learn from one another.
We should provide long-term funding and look at funding specific CNS posts to support secondary breast cancer patients in trusts where there is not a dedicated secondary CNS. We should ensure access to clinically effective drugs at a price that is affordable for the NHS. Let us have a price system. The Minister knows about the issues with the price structure for some drugs, and I know he is pursuing that matter so we get good drugs at a fair price.
I will take the time to list Breast Cancer Now’s recommendations. Its first priority is to fund
“specific interventions to prevent the 23% of breast cancer cases that are attributable to lifestyle factors in England every year.”
We should address the avoidable cancers.
The second priority is:
“Prevent over 1,200 breast cancer deaths by increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units.”
It is so important to have that in place.
The third priority is:
“Urgently invest £39 million in recruitment to the breast imaging and diagnostic workforce to enable breast services to cope with increasing demand over the next ten years.”
I welcome, as we all should, the Government’s commitment to spend an extra £20 billion on health; it is a step in the right direction and it is quite a commitment.
The fourth priority is:
“Adopt new technologies, such as tomosynthesis and Artificial Intelligence, into the breast screening and symptomatic services as soon as proven effective.”
The fifth priority is:
“Transform breast screening to risk stratified screening to spearhead the prevention and earlier diagnosis of breast cancer over the next ten years based on evidence as it emerges.”
As evidence indicates the trends and how to respond to them, we should make the changes to make that happen.
The sixth priority is:
“Ensure that innovative, clinically effective cancer treatments are quickly available to NHS patients at a price that is fair and affordable, including by reviewing the NICE appraisal methodology.”
The seventh priority is:
“Introduce a Catalyst Fund worth £3 million to incentivise generic manufacturers to make it quicker and easier for patients to routinely access cheap, off-patent drugs found to be effective in new uses.”
The eighth priority is:
“Fund new Clinical Nurse Specialist posts to support secondary breast cancer patients in over 120 Hospital Trusts without a dedicated post.”
Those things can make a difference.
The hon. Gentleman talks about having a separate secondary breast cancer nurse as opposed to the breast cancer nurses who are involved in the initial treatment, but that is a discussion about local set-up. The hardest thing is to tell a patient, “It’s back.” To have a nurse to support her, who she knows from five or three years ago, is a big contribution. At our hospital, there was a conscious decision not to have a separate nurse—if a patient got sent to her, that would be a bad sign—but to have the nurse they already knew.
The hon. Lady is right and I accept that we should look at what is being done in Scotland. If there is a better of way of doing something, let us do it that way.
The ninth priority is:
“Improve the Cancer Dashboard by including more detailed data on performance across Cancer Alliance geographies to identify inequalities within and between Alliances.”
The tenth priority is:
“Provide multi-year funding for Cancer Alliances, to increase confidence and encourage long-term thinking to drive investment in innovation, including a dedicated fund to address pathway variation.”
It would be remiss of us all not to thank the charities, which work so hard. We all know them and I will mention just a few I am aware of: Cancer Focus Northern Ireland; CancerCare; and Marie Curie—I met a Marie Curie lady at the Northern Ireland Affairs Committee yesterday. I know Marie Curie’s work because some of my constituents have been referred there in the last month. Its end-of-life care is incredible, as is that of Macmillan Cancer Support.
We need a plan of action and we must have the funding for that plan of action to be put into place. I support so fervently the English reforms that the Minister will put forward, in the hope that the ethos and the funding for my constituents will follow. We are in a different place in Northern Ireland; health is a devolved matter and the responsibility falls under the Northern Ireland Assembly, but it is not functioning correctly at this moment. Men and women need to know that there is a way forward, to ensure that no one dies of breast cancer anywhere in the UK in the not-so-distant future.
I pay tribute to the hon. Member for Crewe and Nantwich (Laura Smith) for securing this debate. I am sorry that it is not more highly subscribed, but it is competing with other debates elsewhere. I also pay tribute to the hon. Member for Bexhill and Battle (Huw Merriman) and particularly to the hon. Member for Lincoln (Karen Lee), whose daughter did not survive. I am sure that that was very difficult for her to speak about; I know she has done so before, and it is very brave of her. I am sure her daughter would be proud.
I declare an interest, which most people know about—I was a breast cancer surgeon for 33 years before coming to this place. Naturally, I am one of the co-chairs of the all-party parliamentary group on breast cancer and I am a Breast Cancer Now ambassador. In my previous life, I was part of its clinical advisory group. In Scotland, I led on developing the quality improvement standards, which we set up in 2000 and which helped to drive up the quality of breast cancer care across Scotland. It was one of the most rewarding periods in my career, because not only did I have the incredible satisfaction that anyone who has worked in the NHS gets from looking after a patient one-to-one—it is an honour to get to do that—but I knew I was contributing every year to cranking up the standards across the country. We have annually gathered peer-reviewed data right back to 2003. It has been great to see that driven up.
The subject of the debate is the future of breast cancer, but being such an old, crusty breast cancer surgeon, I could not resist talking a little about where we have come from. When I started as a medical student, the five-year survival rate was 53%; now, it is more than 80%. That is the journey we have made—a huge journey for the patients, too. It just so happened that my first job on qualifying, and the first three units that I worked in over my first three years, were breast cancer units. I learned so much from the patients on the ward.
Those were the old days, when my light week was 75 hours and my heavy week was 132 hours. My bedroom was on the ward, so I had my tea with the breast ladies. I learned so much about what they hated: people undressing them and not covering them up while starting to talk about them; people talking over their heads. I watched women come back from theatre on a trolley, groping themselves—if they had a lot of bandages and a drip, that meant it was cancer, because the diagnosis was done at surgery. They took out the lump; it went to the lab; they looked at it; they phoned the theatre; and the woman had a mastectomy. No breast care nurse, no pre-operative diagnosis, no discussion and no plan.
There were no women surgeons in Scotland at that time; I remember one of my professors saying, “You should do breast surgery.” I thought it was a bit clichéd for a woman surgeon to do breast surgery, but I looked at my three years’ experience and I thought that the experience of those women was so awful that I could not do anything other than make it better. We have transformed that. By the mid-’80s, we were able to diagnose it at a clinic. Lots of breast surgeons were still not interested in having breast care nurses, but I was involved in the research in Glasgow into the critical need for social and psychological support for women who were going through that journey, looking at the impact of mastectomy on women.
Eventually, we learned that we are kind of not stupid. We are not stressed just because we lose a breast, but because we have cancer; we have kids and we want to see them grow up. We understood that there are two sides that create pressure on women: the change to their body image and the simple stress of the disease, and how to support that. We offered reconstruction; eventually, we moved from mastectomy to preserving the breast when we could. We also know that to support a woman psychologically is to be utterly and completely honest—not to be cruel or rude, but utterly honest. If a patient is lied to, whether by a doctor or family member, that creates a barrier. I have always tried to be utterly and totally honest about what we are facing. We should be part of the patient’s team.
In the late ’70s, tamoxifen came in. Scotland did a lot of the research on that and it looked like it did not make a big difference, until they started doing what we now call meta-analysis—putting a lot of studies together and realising that all the little gains were adding up to an awful lot of lives saved. That has been borne out. There is no magic wand that will get rid of breast cancer; it is about early diagnosis, detailed diagnosis, good surgery, good radiotherapy, good chemotherapy, good hormone treatment and good immunotherapy.
We are talking about the future of breast cancer, and genomics and personalised therapies are in all of the briefs. Tamoxifen was one of the first personalised therapies for a solid tumour to come into existence because it worked only for patients with hormone-sensitive cancers: by testing that tumour, we could tell whether tamoxifen would work. As part of the trial way back in the 1980s, the University of Glasgow did a huge amount looking at how we could test to see whether a cancer was hormone-sensitive. We now do it in a much more efficient way, which is much less time-intensive. Of course, Herceptin, which we discussed so much in the 2000s, works only on patients who carry the human epidermal growth factor receptor 2 marker that makes them sensitive to that drug. We already have that personalised medicine, and a test for it.
My MD thesis was in breast cancer immunology. I utterly believe that immunotherapy will dominate the future of cancer treatment because it is so much better tolerated than chemo and often has a much bigger impact. However, the antibody that became Herceptin was discovered in the second half of the ’80s, when I was in the lab—not that lab, but it was the talk of the steamie because it was an utter breakthrough for everyone studying cancer immunology. That drug went into general trial in 2001. In Scotland, we got access to it routinely on the NHS in 2006, and down here, south of the border, it was the following year—20 years from the bench to routine access. That is one of the challenges we will face in the future.
New treatments have come in, including many in the ’90s, with newer chemotherapy in the form of taxanes, new endocrine treatments, better surgery and better staging. All of that has added up to get us over the 80%. However, as was mentioned, our rates are below the European average.
I remember seeing an interesting paper that compared the UK with Denmark: in all the lower stages and less aggressive diseases, the UK held its own comfortably, particularly because way back in 1988 to 1990 we were one of the early adopters of breast screening whereas other European countries came on only in the second half of the 2000s. However, for the people with really aggressive or advanced disease, we were not matching up. That simply comes back to drug access.
We may get the drug discovered. Scotland plays a significant role—we punch above our weight—within life sciences research in taking things forward and finding new drugs. However, I can say, as one who was routinely involved in trials for years, that it is really demoralising to take on all that extra unpaid time to do the paperwork, sit and explain trials to patients only to find that, as soon as that drug is passed and licensed, we do not get access to it any more.
That is one of the challenges. We are talking about all the amazing new treatments that may come over the hill, but we need to look for an utterly different way of trying to bring them onstream and make them affordable for the NHS. We need a different discussion with the pharmaceutical industry. In exchange, we can offer not personalised data but real-world information thanks to having a joined-up national health service in each of our four nations while many other systems in Europe simply do not. Similarly, our cancer registries are highly accurate.
We face challenges in the future; it is not just that magical treatments will come. Access to drugs is important—and not just new ones. As the hon. Member for Crewe and Nantwich said, there are off-patent drugs such as bisphosphonates, which are cheap in the scale of things, yet only one in five commissioning groups in England are funding that. In Scotland, it is funded in all health boards—my unit took part in that trial.
The idea that something that protects against bone metastasis or strengthens the bones of those driven into the menopause could prevent the spread of breast cancer in all patients was fantastic. In comparison to all the treatments we use, and the one we would use if that patient were to develop metastasis, frankly the cost-benefit is very positive. That should be driven up in England and made routinely accessible. As the hon. Lady mentioned, the report that looked at variation across England showed shocking postcode prescribing.
One of the biggest challenges we face in general in the NHS right across all four systems is workforce. I mention it all the time. It is a challenge in every single NHS specialty, but we have a particular issue in breast cancer and a particular problem in radiology—the mammographic or MRI scanning diagnosis. Many of the consultants who went into breast cancer when screening was developed all became consultants around the late ’80s and early ’90s, and they are all retiring. We are losing a huge cohort, and apparently for every three that retire only two are lined up to replace them. Less than one in five breast screening units report having a full cohort of staff.
Patients cannot be treated in any way if they have not been diagnosed. The issue that led to patients not getting called at the end of breast screening, referred to by the hon. Member for Strangford (Jim Shannon), was partly because of slippage. If those patients had been screened on the correct date, they probably would have been called correctly, but because they slipped past the ages of 70 or 71 without being called, they missed their appointments.
We need to look at that problem, and that includes promoting this specialty. I spent 33 years in it. Yes, sometimes other surgeons are patronising about breast surgery—maybe it is not quite exciting enough for them; there is not enough blood on the floor or enough glamour—but it is one of the most holistic surgical specialties. We look at how to support the patient to recover, getting them back to normal life through exercise, integrating them into their community, providing support groups and having cancer nurse specialists. It is important that those of us in the specialty or who have been in it reach out and attract our younger colleagues to think of it as a life’s job. Cut me through the middle and it’ll still say breast cancer doctor, not MP, and that will never change.
Finally, we do not give remotely enough attention to prevention. The same things that prevent breast cancer will prevent bowel cancer, lung cancer and so many others. The public sometimes get so many conflicting messages, so they go, “Do I drink coffee or not? Do I use a roll-on deodorant or not?” I always say, “There are only five things you need to think about. Don’t do drugs and don’t smoke. If you don’t do either of them, you’ve only got three. They are: keep your booze under control, because we know that contributes directly to breast cancer; watch your diet, because we know that fats and saturated fats in particular contribute to a rise in breast cancer; and be active and healthy.”
If we were to focus much more of our attention on that handful of things that people should do, we could look at reducing the incidence of all of those cancers, whereas they are currently rising. Instead of thinking about hundreds of thousands of pounds at the end of someone’s treatment journey to try to buy another half a year or a year, why do we not try prevention in the first place?
It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith) for leading this timely debate during Breast Cancer Awareness Month and for her excellent speech. It is timely because it is on the same day as Baroness Jowell’s moving memorial service, which I attended prior to this debate. I will say more about why that is relevant later.
I also thank other hon. Members for their excellent contributions—the hon. Members for Bexhill and Battle (Huw Merriman), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friend the Member for Lincoln (Karen Lee). I also thank the amazing campaigners, ambassadors and charities, especially Breast Cancer Now and Breast Cancer Care, for their unswerving support to us as politicians campaigning on the issue, but more importantly to the women, men and families who are living with breast cancer, before, during and after treatment.
As we have heard so movingly today, so many of us, especially those here today, have had our lives touched by breast cancer. I lost my mother-in-law to breast cancer 21 years ago—I have spoken about this before—and that is what inspired me to join the all-party parliamentary group on breast cancer when I became an MP. As the hon. Member for Bexhill and Battle so astutely spotted, I served as co-chair of the group, with the Minister and the hon. Member for Central Ayrshire, and I still serve as the vice-chair. That shows how close breast cancer is to the heart of the health spokespersons of each party and how important it is to work in a cross-party, collaborative way on such an important issue.
More women are surviving breast cancer than ever before. Around 95% of women will survive for one year and more than 80% survive for five years or more. However, the UK still lags behind countries such as Sweden, Portugal, Malta, Germany and France. It is clear that more must be done. Many different issues have been mentioned, but I will specifically talk about breast screening, the workforce and prevention, which others have touched on.
We all know how important early diagnosis is to improving the chances of survival. Breast cancer screening has a huge part to play in this, yet uptake is the lowest it has been in ten years, with stark variations across the country. According to Breast Cancer Now, increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units could prevent over 1,200 breast cancer deaths per annual cohort of eligible women. Will the Government be taking steps to increase breast cancer screening, so that over 1,200 breast cancers deaths can be prevented each year?
The Prime Minister’s commitment as part of the NHS long-term plan to see three out of four cancers detected at an early stage by 2028 included a plan to make screening programmes more accessible and easier to use. Can the Minister elaborate on those plans? Will they include outreach services to groups who are less likely to attend screenings, such as those from certain demographic groups or those with learning disabilities?
Earlier this year it was announced that there had been a serious breast screening invitation error, which meant that over 10 years more than 174,000 women did not receive an invitation to their final breast screening appointment. A review into this error is expected to be published next month. Can the Minister provide an update on that review and is it expected to report on time?
Every year over 55,000 people in the UK are diagnosed with breast cancer, but the failure to address those increasing numbers means that, according to Breast Cancer Now, the number of breast cancer deaths is set to rise within four years. That is why pressure on the workforce needs to be addressed as a matter of urgency. Demand on the breast imaging and diagnostic workforce is set to increase over the next 10 years. We already have a workforce crisis with growing demand, but the problem is only going to get worse if it is left unaddressed. For every three breast radiologists who retire over the next five years, only two are expected to replace them. What plans do the Government have to deal with the growing pressure on an overstretched workforce?
Leaving the EU could also have an impact on our NHS workforce: 5.6% of the NHS workforce in England are from the EU. Changes to immigration rules may exacerbate existing workforce problems for breast cancer patients, particularly among the nursing workforce. Can the Minister provide any clear guarantees to EU citizens working in our NHS? What steps is his Department taking to ensure that the UK continues to attract nurses from the EU?
The current cancer strategy for England includes a recommendation that all patients diagnosed with cancer are supported by a clinical nurse specialist, but this support is not widely available. We heard from my hon. Friend the Member for Lincoln how devastating that is and what it means in reality, when she talked about her experience with her daughter. That support is not available to the majority of the 35,000 people in the UK living with secondary breast cancer. Nearly 72% of hospital organisations in England, Scotland and Wales do not have a dedicated secondary breast cancer clinical nurse specialist. I share Breast Cancer Care’s belief that incurable should not mean unsupported. Does the Minister share that belief and what steps will he take to close the stark disparities and support between primary and secondary breast cancer patients?
The hon. Lady has recognised the comment I made earlier, that our patients all have the support of a cancer nurse specialist, but they do not have a title of secondary nurse specialist. That is something that requires looking into in more detail, so that we can identify places where there really is no support versus places where support is linear, and the decision has been made to follow patients through their whole journey rather than make a decision on a title.
That is an important point and the model that is used in Scotland should perhaps be looked at. I took on board the hon. Lady’s point, when she said that patients who are assigned a secondary breast cancer nurse know what that might mean, whereas if it were someone who had been with the patient on their whole journey, that would be a different experience.
It varies in Scotland. We are a huge and rural country, so we will have some areas where there is a cancer nurse specialist and, for example, islands where there is someone who has the training to act in that role. In Glasgow and Edinburgh there may well be nurses who are different. It was a decision that we took as a team, as we felt it would be hard on the patients to suddenly move to someone new. It is also hard to sustain the nurse, if they are only ever involved in that part of the journey and do not have other days when they see patients get discharged, be well or be diagnosed.
The challenge to the Minister is whether improvements to the breast cancer workforce will include recruiting and training additional secondary breast cancer nurses, clinical nurse specialists—whatever we may decide to call them—so that patients have the vital support they need and no one has to witness their loved ones suffering in agony, with only over-the-counter painkillers to ease the pain, as my hon. Friend the Member for Lincoln so bravely testified to earlier.
Does my hon. Friend agree that the withdrawal of nursing bursaries cannot fail to have impacted on the numbers of nurses training? There are figures out today—I have been on the radio this morning. I think there has been more than a 30% drop in the number of people training to be nurses since the nursing bursary was withdrawn. That cannot fail to have had an impact. It impacts on radiographers as well, because they train for three years, then for another year after that to do mammograms. Does she agree that those bursaries absolutely must be reinstated?
Yes, I agree. Obviously, that is why it is in our manifesto that we would reinstate those nursing bursaries. I would urge the Government to look at this closely, especially in light of Brexit, and what might happen post Brexit, with regard to the EU workforce, as I already mentioned.
Finally, I will move on to prevention. It is a challenge to us all to live healthier lives. I do not stand here saying I am doing a very good job, but we know that regularly drinking alcohol, as the hon. Member for Central Ayrshire mentioned earlier, and being overweight or obese, can increase the risk of developing breast cancer—and most cancers—as can smoking and lack of exercise. Regular physical exercise and reducing all the above can reduce the risk. Researchers estimated that 23% of breast cancers are preventable through lifestyle changes. That means there were approximately 10,600 preventable cases in 2016. Turning that into money, approximately £102 million in treatment costs could have been saved in 2016 if all those cases had been prevented. I know that may not be completely achievable, but since 2015, public health budgets have been cut by 3.9% a year until 2020-21. Has the Minister made any assessment of the effect that cuts to public health budgets have had on the incidence of breast cancer, and will he commit, as much as he can, to an increase in public health funding to help to prevent more cases of breast cancer? I know that might be above his pay grade; he is not the Chancellor—yet.
In closing, I will touch on secondary breast cancer. More than half of women are given no information about the signs and symptoms of breast cancer returning. Will the Minister look into ensuring that all patients are advised at the end of their primary breast cancer treatment about lifestyle and symptoms, so that where possible all cases of incurable secondary breast cancer can be prevented? I know that, like me, the Minister is incredibly passionate about breast cancer and that he will take much if not all of what he has heard today back to his Department to work on, so that he can achieve the best future for breast cancer.
On the day of Dame Tessa Jowell’s memorial, I will end by quoting from her magnificent last speech in the House of Lords in January this year, when she said:
“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”
She said that she hoped the debate would give hope to other cancer patients,
“so that we can live well together with cancer—not just dying of it”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
Perhaps her most precious legacy will be not only Sure Start and the Olympics, as wonderful as they are, but a better future for everyone with any form of cancer.
Thank you for chairing our session today, Mr McCabe. I add my congratulations to the hon. Member for Lincoln (Karen Lee) on securing the debate and the hon. Member for Crewe and Nantwich (Laura Smith) on leading us off today. Breast cancer sadly affects so many of us so personally. It is always a privilege to respond to any debate in this House, especially on cancer and more especially on breast cancer, and this has been a constructive, small and perfectly formed debate.
It is always a pleasure to follow my shadow Minister and friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson); I think this is the first time that a debate has been led by all three chairs of the same all-party parliamentary group, speaking for their respective parties. It was important to us when we chaired the group that we had the three main parties in the chair. The third chair was then held by the Liberal Democrats—remember them?—[Laughter.] Stop it. When the hon. Member for Central Ayrshire (Dr Whitford) joined the House, it was a real pleasure that she came on board and took that seat.
I will start by saying, “Happy BCAM!” There is much to celebrate, as hon. Members have said, and it is Breast Cancer Awareness Month, or BCAM for short. I pay tribute to all the people who are here, the survivors—survivorship is very important—and to all the people who have gone. Macmillan Cancer Support ran a heartfelt campaign earlier this year on the idea that “A mum with cancer is still a mum”, which was one of the best pieces of advertising I have seen in the health space for a long time. The reason I say, “Happy BCAM!” is that the people who have gone were still mums, daughters and sisters, even while they were going through their challenges. That is very important. Even children who lose their battle with cancer after being on this earth for a matter of days leave an indelible mark, because they were here for a few days. It is important to me that we always remember that, and I always do.
The title of today’s debate on the Order Paper is “Future of breast cancer”. The hon. Member for Washington and Sunderland West said to me once in one of our group meetings, “You will be cancer Minister one day.” If she could predict something else great for me, that would be excellent.
Oh yes; the hon. Lady has already said Chancellor today. I am not sure about that one.
As the cancer Minister, I want a future where there is no breast cancer. The hon. Member for Strangford (Jim Shannon) mentioned that, and I think all hon. Members who have contributed this afternoon would like to see a future where there was no breast cancer. One day, perhaps—but the statistics show that we are making good progress. That is why I said that there are things to celebrate. We are ensuring that more people than ever survive breast cancer. As has been said, 10-year survival rates have almost doubled, from around 40% to nearly 80%, in the last 40 years.
I hope I do not need to say it, but cancer is a huge priority—the priority—for me. The Prime Minister chose to make it a central point of her party conference speech this month, and there was a reason for that; it is a huge priority for her and for her Government. Survival rates have never been higher, and they have been increasing year on year. Of course the Prime Minister celebrates that, but it is also why she announced a very ambitious package of measures for cancer care and treatment, showing that cancer will be absolutely central to the long-term plan for the NHS, which she has challenged NHS England to write before the end of this year and of which I will say more later. We are committed to investing an extra £20 billion a year in our NHS. The investment will build on the success we have already achieved through the implementation of the cancer strategy for England. I pay tribute to Harpal Kumar and those at Cancer Research UK who put that strategy together. We will build on that legacy and take it forward into the long-term plan.
In opening the debate, the hon. Member for Crewe and Nantwich raised a number of good points. She talked about secondary breast cancer data collection—a number of people did so, but she raised it first. She is right that the robust and timely collection and sharing of data is vital for improvements in breast cancer services. If we do not measure it, we do not know, and if we do not know, we cannot act. The National Cancer Regulation and Analysis Service, or NCRAS, collects data on all cancers diagnosed in England, with the data collection specified by the cancer outcomes and services dataset. That data collection of secondary breast cancers was mandated as part of the COSD for diagnoses from April 2013 onwards.
I remember, with my shadow Minister, taking a delegation to see Prime Minister David Cameron in No. 10 to talk about that exact issue just before Christmas; I remember our photo by the tree. It is good that that happened, but it is evident, comparing the collected data with sources in academic literature, that a large proportion of cases are still not being reported in the COSD. That is of great frustration to me. NCRAS continues to work with NHS trusts to improve the completion of the data, and we have redesigned aspects of the COSD to allow more relevant information on occurrence to be captured, but I do not for one minute shirk the fact that there is more to do in this area, and I assure the House and colleagues that I will constantly redouble my efforts in that regard.
I touched on the quality improvement project that we started in 2000 in Scotland, looking at many measures right along the pathway that the patient went through. In essence, it was assessing the whole team: how the team functioned, what the surgery was like, what the diagnosis was like and what the chemotherapy was like. The problem is that that sort of audit has not happened, other than for screening patients, in England for quite some time. While I welcome the collection of data on secondary cancer, we need units to have the ability to look at their performance on patients the first time around, to try to prevent that secondary cancer.
The hon. Lady is right. That is why COSD stands for the cancer outcomes and services dataset. It is not specific to breast cancer, nor should it be, because there are sadly lots of different cancers, but she is right that it should be measuring, judging and analysing both the outcomes and the services that lead to that outcome. As ever, she is dead right.
The point was made about off-patent drugs being found to be effective in new uses. The Prime Minister set out, both in her party conference speech and when we launched the new NHS long-term plan, how a key ambition of that plan will be to speed up access to groundbreaking treatments, with a quicker translation of new breakthroughs into practice through investment in world-leading cancer research centres.
Although bisphosphonates—I always struggle to say that—are not licensed for the treatment or prevention of secondary breast cancer, clinicians can prescribe them off-licence or off-label, subject to local funding policies, if they consider them to be clinically appropriate for an individual. The hon. Lady was right to raise that point.
Not at the moment. The hon. Lady and others also talked about the long-term funding of cancer alliances. NHS England and I are absolutely committed to the cancer alliances. We have backed them with significant funding and we will continue to support their development fully, ensuring that they have the funding that they need—in this cycle, at the very least—to transform cancer services in the long run.
I take a close and continued interest in the cancer alliances, as Members would expect. Just this week, I sat down with Cally Palmer, the NHS England’s national cancer director, to do what I call a deep dive, going through each cancer alliance in England. I want to know who runs them, where there are leadership challenges, where they struggle to meet the 62-day target and why, and I want to know their turnaround plans for that, including replacing people who are not performing. We do not expect or accept poor performance in a trust, and we do not expect or tolerate it in schools. Cancer alliances spend a lot of public money and they should not be treated any differently.
I want much greater transparency from the cancer alliances. I suspect that if I asked every Member here whether they knew the name of their local health trust chief executive, they would say that they did—and they probably have them on speed dial, as I do. If I asked those Members whether they knew the name and number of the person who leads their cancer alliance, I doubt that they would. I assure Members that that will change.
Bisphosphonates and other off-patent drugs are usually old drugs, which ought to be cheaper and therefore very cost-effective. The Minister and another Member mentioned that these drugs are not relicensed. A private Member’s Bill to set up a method for relicensing drugs for a new purpose was unfortunately talked out by the then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), in November 2016. We have agreement that these drugs will go into the “British National Formulary”, which will hopefully increase their use. However, I notice that the shocking increase in prices of off-patent drugs that led to the introduction of the Health Service Medical Supplies (Costs) Act 2017 has not changed. The regulations are not being used. NHS England is being charged ridiculous prices for old drugs and for specials that are made up for individuals. Why are we not using that legislation to drive down those prices, so that all women in England could access drugs that are not—or should not be—actually that expensive?
There is so much more that I want to get on to, so I will not go into that in any great deal, but I will give the hon. Lady a note on that. Lord O’Shaughnessy, who is part of the Department’s drugs team and who speaks on health in the other place, is working on the implementation of that legislation. The hon. Lady has asked me about this before, and it frustrates me incredibly that that Act is not being implemented more quickly, but that should not be taken as any indication of a lack of desire on our part to do so. However, I take the hon. Lady’s point.
It is still right for those prescribing decisions to be made by clinicians. However, I want breakthrough drugs to make it on to the market more quickly, instead of staying in the cancer drugs fund. There are good examples of that related to breast cancer, and we want to see it happen much more quickly.
My dear hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke personally and passionately —as always—about these matters, and I thank him for that. He raised lots of issues, including the screening programme. Everyone says that the breast cancer screening programme is a critical tool in ensuring that we catch breast cancers as early as possible, when there is a higher chance of successful treatment. However, we know that there is much more to do to improve uptake. In her party conference speech, the Prime Minister set out that we would transform our screening programmes, making them more accessible and easier to use and utilising the best research and technology. Further detail on that will be set out in the long-term plan later this year.
My hon. Friend also asked about technology in screening. I will come on to the screening scandal in a moment, but it is very much our aim that in the future patients will be able to make much greater use of technology to be informed of things, such as GP or screening appointments, rather than relying on Royal Mail. Our NHS app is being piloted and will be rolled out from December this year. That is just the start of the technology revolution that we want to see and that the Secretary of State has made one of his priorities. We expect the independent breast screening inquiry to make recommendations in that area.
Several Members asked about the inquiry into the breast screening problems that we had. We expect that to report shortly. I do not have an expected date, but several Members, including the hon. Member for Central Ayrshire and the shadow Minister, asked whether it is on schedule. I believe that it is, and I look forward to that report very much. With somebody as serious as the Macmillan chief executive leading that review, alongside others, I know that it will challenge us, as it is meant to; the former Secretary of State set it up to do so.
My hon. Friend the Member for Bexhill and Battle mentioned the importance of early diagnosis. I am proud of Public Health England’s Be Clear on Cancer campaign, which I am responsible for. PHE ran its 14th Be Clear on Cancer campaign through February and March of this year, focusing on breast cancer in women aged over 70—a subject that is very close to the hearts of members of the APPG. Research shows that older women are more likely to delay presenting to their GP with breast cancer symptoms.
The campaign previously ran in 2014 and 2015, and an evaluation showed an increased awareness of the key messages that it promoted and, even more importantly, that more cancers were diagnosed during the campaign period. We are running the “Blood in Pee” campaign at the moment—I have all the glamourous things in my portfolio—and Be Clear on Cancer will go forward and from strength to strength.
I always keep an open mind. The truth is—the hon. Member for Central Ayrshire knows exactly what I will say—that although the screening review will no doubt make recommendations on that, there is a very heated and divided debate within the breast cancer community around screening, and not just about the age at which to begin it. We had the AgeX age extension trial, which broadened the range of ages at which we screen, but there is absolutely no consensus within the breast cancer community on the benefit of screening. That debate continues and rages strongly, and it is for policy makers to listen to all the different views, as the screening review will do.
Several Members, including the shadow Minister, rightly mentioned clinical nurse specialists and the cancer workforce. Last December, Health Education England published its first ever cancer workforce plan, which committed to the expansion of capacity and skills in fighting the big C.
Let me make this point. That plan includes an ambition to attract qualified people back to the NHS through domestic and international recruitment. HEE also plans to expand the number of clinical nurse specialists and to develop clear CNS competencies and routes into training. This will see every breast cancer patient having access to a CNS or other support worker by 2021.
We are committed to ensuring that all that happens. I saw a lot of news coverage last weekend on access to CNSs, and I completely accept that we have more to do. However, I have been very interested in listening. These debates are not only about me sitting here and waiting to read out my speech; they inform me, as much as anything. I was very interested in the discussion between the Labour and Scottish National party Front Benchers about what CNSs are called and the multidisciplinary team that they could be part of to offer support to women as they are going on this journey. I will definitely take that away.
May I ask the Minister to respond directly to my comment that according to the figures out this morning—I know, because I was given them and asked to comment on them—the numbers of people training to be a nurse have dropped by just over 30% since the bursaries were withdrawn? The Government talk and talk about associate nurses and apprentice nurses, but there is not the take-up for those posts, and an apprentice nurse takes four years to train, so will he respond directly to my comments? Of course, the issue affects not just nurses but radiographers, as I said.
The general point I would make is this. The hon. Lady said that people cannot live on good will; they have to have pay rises, and that is why I am very pleased that we have lifted the public sector cap pay. The significant pay rise that will be coming is welcome. Also, as well as expanding the number of nurse training places by 5,170, we are expanding the skills of specialist cancer nurses. There are 52,000 nurses training in the NHS, with more to come, thanks to our 25% increase in training places. The debate on bursaries is very live. That is discussed every single time we have Health questions—I dare say it will be again on Tuesday—but the Government have been very clear about our vision for the health education workforce and where we see nurse training places and the nurse apprenticeship scheme sitting in that. That is probably all I can add at the moment on that issue.
I want to touch on so many other different things. The hon. Member for Central Ayrshire, the shadow Minister and everyone else who spoke in the debate talked about prevention, and of course the title of the debate on the Order Paper is “Future of breast cancer”, so yes, we need to do a lot more to prevent people from developing cancer—not just breast cancer, but cancer—in the first place. As the Minister responsible for public health and dealing with cancer, I know that encouraging people to live healthier lifestyles can be one of the most effective ways to prevent cancer. Yes, there have been challenging budgets since we took office in 2010, but I refuse to bring politics into the cancer debate. All I will say is that Governments do have to live within their means. Governments do not have any money of their own; they have only our constituents’ money. We are spending £16 billion on the public health budget in England during this spending review period, but difficult decisions have been made. Clearly, I cannot pre-empt the spending review next year. I know what the NHS is getting, because we have pre-empted that ourselves, but we will make our announcements around the future of the public health grant, which obviously comes through a different Department, in due course.
I want to talk about the prevention point. Better prevention is not a silver bullet. I wish it were, but the truth is that cancer is indiscriminately cruel. We have had statistics today on the number of cancers that are preventable. Some two thirds of cancers are just down to bad luck. That is a horrid fact of life, and a horrid fact of life that every Member in this Chamber lives with every day. Cancer can have devastating effects on children, and on people who have lived the healthiest of lives, but we can have a huge impact and ensure that more people live their lives free of cancer if we focus on the prevention message.
Obesity is relevant. We talk a lot about childhood obesity. That is obviously because big children become big adults. Cancer Research UK has been very good in this space in making the connection between obesity and cancer. When we made the connection between smoking and lung cancer, it was a game changer. CRUK makes the connection between obesity and cancer. I am not fat shaming in saying that; it is just a matter of fact that obesity is a contributing factor to cancers. I am told that 8% of breast cancer cases in 2015 were the result of being too heavy. We need to do better on obesity, and we could talk for hours about the childhood obesity strategy alone. There are of course the issues of diet and physical activity. Earlier this month I was at the G20, talking about strengthening health systems, obesity and physical activity, and everyone around the world concurs on that.
I shall close on prevention by talking about alcohol, which the hon. Member for Central Ayrshire mentioned. It is a big breast cancer risk. That is the truth. Women who drink more alcohol have higher rates of breast cancer; women who do not drink have a lower risk of breast cancer compared with those who do. Risk rises with alcohol consumption, and no particular level of intake is risk free. That is the truth.
I want to return to the screening failure, because screening was referred to by the hon. Member for Strangford. He is in his place as always—God bless him. However well we are doing, we cannot be complacent. I constantly look at and worry about the screening figures. With regard to the failing in the national breast screening programme in England, many things come across our desk as Ministers that we wish did not come across our desk, and there are many things that we lie awake at night and worry about. Some things kick you where you do not want to be kicked as a man, and the breast screening programme failure in England kicked me very hard there when it happened. It resulted in thousands of women between the ages of 68 and 71 not being invited to their final screening. That is a stark reminder that however well we think we are doing, we have to do better. The former Secretary of State apologised unreservedly for it. He said that all we can do is put it right, and we are putting it right in terms of inviting people back for screening. We are determined; the independent review was set up to investigate and report on the circumstances of breast screening failure. That is expected to report shortly. It will challenge us and make very challenging recommendations. I look forward to discussing that with hon. Members.
The five-year survival rate for breast cancer is already 86%, as has been said. Some in the breast cancer community worry that the long-term plan and the Prime Minister’s new 75% early-stage detection ambition for cancer mean that we have no ambition left for breast cancer. Earlier this week the national cancer director and I discussed the long-term plan. I was absolutely clear with her, and she agrees, that our long-term ambitions cover all cancers, including breast cancer. The 75% five-year survival aim is ambitious—we would love many cancers to be even remotely there—but it is not the limit of our ambition.
As I said, I want a future in which there is no breast cancer. The NHS does well at diagnosing breast cancer, but it must do a lot better at preventing it. We must continue until the five-year survival figure is 100%, and I do not say that as a naive ambition. I want to make that point clear, because I know that some in the breast cancer community are concerned about that.
I pay tribute to the selfless work done by the people who will deliver the vision in the cancer strategy and the wider long-term plan. Obviously, doctors and nurses are at the sharp end, and I visit them when I go out and about. They, not Ministers, are the people behind the highest ever survival rates. I also want to add my thanks to the charities, which I have enjoyed working with. Breakthrough Breast Cancer joined with the Breast Cancer Campaign to become Breast Cancer Now. I enjoy working with Delyth, Baroness Morgan, of Breast Cancer Now and with Breast Cancer Care and Breast Cancer Haven. I have a lot of time for Breast Cancer Haven, which creates havens to help women to feel human and normal again after treatment. It does a lot of good work.
NHS England and I, with the support of what I always call Team Cancer, are utterly committed to making the ambitions that we set out in our long-term plan and our new cancer strategy a reality. That will ensure that we take a huge leap forward, over the next 10 years, to a future in which cancer has no future.
I thank everyone who has attended the debate—especially because I am not sure whether the heating bill has been paid in here. It is absolutely freezing, so well done to all those in the Public Gallery.
Breast cancer is the most common cancer in the UK. Every 45 minutes, another life is lost to the disease; it claims almost 1,000 lives every month in the UK. I pay special tribute to the charities that help to raise awareness, support those affected in all our communities and, of course, fund research into this devastating disease. Thanks to that research, more people are surviving breast cancer than ever before. I hope that I live to see the day when everyone who develops breast cancer lives.
I want to thank the Minister, the shadow Minister and the hon. Member for Central Ayrshire (Dr Whitford), who represents the Scottish National party. Her expertise in this area is very welcome, and I have learned a lot. I thank the hon. Members for Strangford (Jim Shannon) and for Bexhill and Battle (Huw Merriman) for their contributions. Special thanks go to my hon. Friend the Member for Lincoln (Karen Lee), who spoke so passionately about her own experience. Her daughter would be very proud of her work and all that she does, and her friends and family are proud of her too.
As a 33-year-old mother of two young children, I would welcome earlier screening with open arms, but as the hon. Member for Central Ayrshire pointed out, it is also about education in how to check for lumps—what they look like and feel like. I check my breasts, but I am not convinced that I am doing it right, so it would be good to be shown how to do that. I will call on her from now on—she will not be able to get rid of me.
Praise must go to the all-party parliamentary group on breast cancer for its report on the geographical inequalities. I encourage all hon. Members who are yet to read the report to do so. I hope to see everyone join in for Wear it Pink tomorrow. My trophy for winning the title of best-dressed MP for Wear it Pink is in pride of place between my son’s football trophies, but my two-year-old daughter has claimed it as her own prize—it is her “booby trophy”. Thank you for chairing the debate, Mr McCabe and thanks again to everyone who has attended.
Question put and agreed to.
That this House has considered the future of breast cancer.